Rhabdomyolysis and swelling in the right leg

Patient

Q: I was released from Hospital in Indianapolis on August 2, 2011 after admission July 27, 2011. There were also four previous trips to the the ER since late July. I was diagnosed with Rhabdomyolysis.I was relaeased becasue my CPT values continued to drop after the 5th and 6th day in the ER. I released with a score over 5,000. But that was with 24:7 IV Saline and Antibiotics. They never checked my CPT after removing the IV. I am suffering greatly now with excruciating pain and swelling in my right leg and foot. I need to discuss and review the sweeling and loss of sensation I have on my right side. I can walk very poorly due to problems on my right side. What Diuretics can i take OTC to reduce thje swelling?

Doctor

A:    Rhabdomyolysis means striated muscle dissolution or disintegration, with muscle injury, large quantities of potassium, phosphate, myoglobin, creatine kinase (CK) and urate leak into the circulation. This is a potentially serious clinical and biochemical condition which most serious complication is the acute renal failure. Myoglobin in the renal glomerular filtrate can precipitate and cause renal tubular obstruction, leading to renal damage. Approximately 26,000 cases of rhabdomyolysis are reported annually in the United States. Early diagnosis and treatment intervention are vital in order to get a full recovery and avoid the many complications that may develop. The most common causes are alcohol abuse, muscle overexertion, muscle compression and the use of certain medications or illicit drugs. I strongly recommend you to go to the ER and get a comprehensive evaluation, to rule out one of the complications: Compartment syndrome, this may be an early or late complication, resulting mainly from direct muscle injury or vigorous muscle activity. This complication occurs primarily in muscles whose expansion is limited by tight fascia, such as the anterior tibial muscles (leg). Peripheral pulses may still be palpable, in which case nerve deficits (mainly sensory) are more important findings. A delay of more than six hours in diagnosing this complication can lead to irreversible muscle damage or death. The treatment is Decompressive Fasciotomy and it should be considered if the compartment pressure is greater than 30 mm Hg. in the affected area.

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